儿童精神分裂症患者认知功能的研究

Study of cognitive function in children with schizophrenia

目的:探讨儿童精神分裂症患者的认知功能及其与临床因素的关系。方法:40例儿童精神分裂症患者(病例组)治疗前、治疗24周后分别给予阳性与阴性症状量表(PANSS)及神经心理学测验[包括注意力测验、WMS-R-逻辑记忆、数字广度(DS)、连线测验A和B(TMT-A,TMT-B)、词汇流畅性测验(VFT)、Stroop色词测验(SCWT)和威斯康星卡片分类测验(WCST)]评估其病情及认知功能,神经心理学测验成绩与59名健康儿童(对照组)进行比较;分析患者的认知功能与相关临床因素的关系。结果:治疗24周后病例组PANSS总分、阳性症状分(47.70±10.18、9.00±2.40)较治疗前(76.80±8.49、21.63±7.98)显著下降(P均<0.01)。治疗前病例组除VFT外,余15项神经心理测验成绩显著差于对照组(P<0.05或P<0.01);治疗后病例组只在数字顺背(FDS)、TMT-A、彩色文字阅读(Stroop-c)、WCST完成分类数(Cc)、WCST正确应答数(Rc)成绩较治疗前明显提高(P<0.05或P<0.01);除FDS、VFT、Stroop-c及Rc外,其余12项成绩仍明显差于对照组(P<0.05或P<0.01)。FDS与阳性症状分、阴性症状分(r=0.366、0.343,P=0.020、0.030)、VFT与性别(r=0.321,P=0.043)、TMT-A与起病年龄(r=0.331,P=0.037)有较弱的相关性。控制性别、起病年龄后,阳性症状量表减分率与TMT-B(偏相关系数=-0.351,P=0.031)、数字倒背(BDS)(偏相关系数=-0.374,P=0.021)呈负相关。结论:儿童精神分裂症患者存在注意、记忆、执行功能等广泛的认知功能障碍,可能是独立的临床核心症状之一。

Objective：To explore the cognitive function and its correlated clinical factors in children with schizophrenia.Method：The disease severity was assessed with positive and negative symptom scale （PANSS） and cognitive function was measured by neuropsychological test including [attention test,WMS-R-logical memory,digital span（DS）,trail making test A and B（TMT-A,TMT-B）,verbal fluency test （VFT）,stroop colorword test （SCWT） and Wisconsin card sorting test （WCST）]in 40 children with schizophrenia （case group） before and after 24 weeks treatment respectively.The achievement of neuropsychological test was compared with 59 normal children（control group）.The correlation between cognitive function and relevant clinical factors was analyzed.Results：After 24 weeks of treatment,the total score of PANSS and positive symptoms score （47.70±10.18,9.00±2.40） were decreased significantly than those at before treatment （76.80±8.49,21.63±7.98） in case group （all P0.01）.Compared with control group,the scores of 15 testing of neuropsychological test in case group before treatment were worse except VFT（P0.05 or P0.01）;24 weeks after treatment,the scores of forward digit span（FDS）,TMT-A,Stroop-c,complete classification number of WCST（Cc） and right category of WCST （Rc） were improved（P0.05 or P0.01）.Except FDS,VFT,Stroop-c and Rc,results of the rest 12 testings were still worse than those in control group （P0.05 or P0.01）.There were mild positive correlation between FDS and scores of positive and negative symptom （r=0.366,0.343;P=0.020,0.030）,VFT and gender（r=0.321,P=0.043）,TMT-A and the age of onset （r=0.331,P=0.037）.There were negative correlation between reduceing ratio of positive symptom with TMT-B （Pr=-0.351,P=0.031） and BDS（Pr=-0.374,P=0.021） only after controlling gender and the age of onset.Conclusion：There are extensive cognitive function impairment including attention,memory and executive function in children with schizophrenia,which may be one of the crucial clinic-independent symptom.